Provider Demographics
NPI:1689868176
Name:RANNEKLEIV, KEREN (OT)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:RANNEKLEIV
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 PALMER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2483
Mailing Address - Country:US
Mailing Address - Phone:914-834-4346
Mailing Address - Fax:914-834-5509
Practice Address - Street 1:2039 PALMER AVE STE 202
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2483
Practice Address - Country:US
Practice Address - Phone:914-834-4346
Practice Address - Fax:914-834-5509
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0100111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0100111OtherSTATE LIC #